Thrombotic Microangiopathy among Hospitalized Patients with Systemic Lupus Erythematosus in the United States
Background: This study aimed to evaluate thrombotic microangiopathy’s (TMA) incidence, risk factors, and impact on outcomes and resource use in hospitalized patients with systemic lupus erythematosus (SLE). Methods: We used the National Inpatient Sample to construct a cohort of hospitalized patients...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2020-12-01
|
| Series: | Diseases |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2079-9721/9/1/3 |
| _version_ | 1797543601346969600 |
|---|---|
| author | Aleksandra I. Pivovarova Charat Thongprayoon Panupong Hansrivijit Wisit Kaewput Fawad Qureshi Boonphiphop Boonpheng Tarun Bathini Michael A Mao Saraschandra Vallabhajosyula Wisit Cheungpasitporn |
| author_facet | Aleksandra I. Pivovarova Charat Thongprayoon Panupong Hansrivijit Wisit Kaewput Fawad Qureshi Boonphiphop Boonpheng Tarun Bathini Michael A Mao Saraschandra Vallabhajosyula Wisit Cheungpasitporn |
| author_sort | Aleksandra I. Pivovarova |
| collection | DOAJ |
| description | Background: This study aimed to evaluate thrombotic microangiopathy’s (TMA) incidence, risk factors, and impact on outcomes and resource use in hospitalized patients with systemic lupus erythematosus (SLE). Methods: We used the National Inpatient Sample to construct a cohort of hospitalized patients with SLE from 2003–2014. We compared clinical characteristics, in-hospital treatments, outcomes, and resource use between SLE patients with and without TMA. Results: Of 35,745 hospital admissions for SLE, TMA concurrently presented or developed in 188 (0.5%) admissions. Multivariable analysis showed that age ≥ 40 years and Hispanics were significantly associated with decreased risk of TMA, whereas Asian/Pacific Islanders and history of chronic kidney disease were significantly associated with increased risk of TMA. TMA patients required more kidney biopsy, plasmapheresis, mechanical ventilation, and renal replacement therapy. TMA was significantly associated with increased risk of in-hospital mortality and acute conditions including hemoptysis, glomerulonephritis, encephalitis/myelitis/encephalopathy, hemolytic anemia, pneumonia, urinary tract infection, sepsis, ischemic stroke, seizure, and acute kidney injury. The length of hospital stays and hospitalization cost was also significantly higher in SLE with TMA patients. Conclusion: TMA infrequently occurred in less than 1% of patients admitted for SLE, but it was significantly associated with higher morbidity, mortality, and resource use. |
| first_indexed | 2024-03-10T13:47:57Z |
| format | Article |
| id | doaj.art-effe5eedd1cb4713866cd384a3e60dd8 |
| institution | Directory Open Access Journal |
| issn | 2079-9721 |
| language | English |
| last_indexed | 2024-03-10T13:47:57Z |
| publishDate | 2020-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diseases |
| spelling | doaj.art-effe5eedd1cb4713866cd384a3e60dd82023-11-21T02:28:14ZengMDPI AGDiseases2079-97212020-12-0191310.3390/diseases9010003Thrombotic Microangiopathy among Hospitalized Patients with Systemic Lupus Erythematosus in the United StatesAleksandra I. Pivovarova0Charat Thongprayoon1Panupong Hansrivijit2Wisit Kaewput3Fawad Qureshi4Boonphiphop Boonpheng5Tarun Bathini6Michael A Mao7Saraschandra Vallabhajosyula8Wisit Cheungpasitporn9Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USADivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USADepartment of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA 17101, USADepartment of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, ThailandDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USADepartment of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USADepartment of Internal Medicine, University of Arizona, Tucson, AZ 85721, USADivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USASection of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USADivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USABackground: This study aimed to evaluate thrombotic microangiopathy’s (TMA) incidence, risk factors, and impact on outcomes and resource use in hospitalized patients with systemic lupus erythematosus (SLE). Methods: We used the National Inpatient Sample to construct a cohort of hospitalized patients with SLE from 2003–2014. We compared clinical characteristics, in-hospital treatments, outcomes, and resource use between SLE patients with and without TMA. Results: Of 35,745 hospital admissions for SLE, TMA concurrently presented or developed in 188 (0.5%) admissions. Multivariable analysis showed that age ≥ 40 years and Hispanics were significantly associated with decreased risk of TMA, whereas Asian/Pacific Islanders and history of chronic kidney disease were significantly associated with increased risk of TMA. TMA patients required more kidney biopsy, plasmapheresis, mechanical ventilation, and renal replacement therapy. TMA was significantly associated with increased risk of in-hospital mortality and acute conditions including hemoptysis, glomerulonephritis, encephalitis/myelitis/encephalopathy, hemolytic anemia, pneumonia, urinary tract infection, sepsis, ischemic stroke, seizure, and acute kidney injury. The length of hospital stays and hospitalization cost was also significantly higher in SLE with TMA patients. Conclusion: TMA infrequently occurred in less than 1% of patients admitted for SLE, but it was significantly associated with higher morbidity, mortality, and resource use.https://www.mdpi.com/2079-9721/9/1/3systemic lupus erythematosusSLEhospitalizationoutcomesrisk factormortality |
| spellingShingle | Aleksandra I. Pivovarova Charat Thongprayoon Panupong Hansrivijit Wisit Kaewput Fawad Qureshi Boonphiphop Boonpheng Tarun Bathini Michael A Mao Saraschandra Vallabhajosyula Wisit Cheungpasitporn Thrombotic Microangiopathy among Hospitalized Patients with Systemic Lupus Erythematosus in the United States Diseases systemic lupus erythematosus SLE hospitalization outcomes risk factor mortality |
| title | Thrombotic Microangiopathy among Hospitalized Patients with Systemic Lupus Erythematosus in the United States |
| title_full | Thrombotic Microangiopathy among Hospitalized Patients with Systemic Lupus Erythematosus in the United States |
| title_fullStr | Thrombotic Microangiopathy among Hospitalized Patients with Systemic Lupus Erythematosus in the United States |
| title_full_unstemmed | Thrombotic Microangiopathy among Hospitalized Patients with Systemic Lupus Erythematosus in the United States |
| title_short | Thrombotic Microangiopathy among Hospitalized Patients with Systemic Lupus Erythematosus in the United States |
| title_sort | thrombotic microangiopathy among hospitalized patients with systemic lupus erythematosus in the united states |
| topic | systemic lupus erythematosus SLE hospitalization outcomes risk factor mortality |
| url | https://www.mdpi.com/2079-9721/9/1/3 |
| work_keys_str_mv | AT aleksandraipivovarova thromboticmicroangiopathyamonghospitalizedpatientswithsystemiclupuserythematosusintheunitedstates AT charatthongprayoon thromboticmicroangiopathyamonghospitalizedpatientswithsystemiclupuserythematosusintheunitedstates AT panuponghansrivijit thromboticmicroangiopathyamonghospitalizedpatientswithsystemiclupuserythematosusintheunitedstates AT wisitkaewput thromboticmicroangiopathyamonghospitalizedpatientswithsystemiclupuserythematosusintheunitedstates AT fawadqureshi thromboticmicroangiopathyamonghospitalizedpatientswithsystemiclupuserythematosusintheunitedstates AT boonphiphopboonpheng thromboticmicroangiopathyamonghospitalizedpatientswithsystemiclupuserythematosusintheunitedstates AT tarunbathini thromboticmicroangiopathyamonghospitalizedpatientswithsystemiclupuserythematosusintheunitedstates AT michaelamao thromboticmicroangiopathyamonghospitalizedpatientswithsystemiclupuserythematosusintheunitedstates AT saraschandravallabhajosyula thromboticmicroangiopathyamonghospitalizedpatientswithsystemiclupuserythematosusintheunitedstates AT wisitcheungpasitporn thromboticmicroangiopathyamonghospitalizedpatientswithsystemiclupuserythematosusintheunitedstates |